leaving clinic with Patients still in exam rooms?

[bethburlson]

The large Hospital I work at, I transferred to an eye/plastics clinic-in interview I was told I would work clinic hours-stay over a little once in a while/in reality a Dr stays over 3 times a week and sometimes till 9pm-I questioned this and the (non medical) manager told me just to leave when I'm ready (with Pts still in exam rooms)-the only one left in this clinic is the Dr and a resident (not even a front desk person). when I asked to talk to the head nurse-they would not let me (she works at a different site). These eye patients are not optical Pts and some are in bad shape. I feel this is unethical leaving Pts.

Can I have fellow Nurse feedback?

Thanks, Beth

[JustBeachyNurse, LPN]

Again why have you decided that a licensed physician and resident are incompetent at running a code when physicians must sign off on code protocols for nurses to implement? Most teaching facilities physicians and residents run codes, if not an APN. Why have you decided that your skill set is superior to that of a physician, which is how your posts are reading. It's not like you are leaving an unlicensed assistance personnel and receptionist to close a clinic. A licensed resident physician and a highly specialized physician/surgeon most certainly must be competent to run a regional referral center that accepts the patients that no one else will or erred and caused further issues.

Are you overestimating your expertise & value as a new hire? Do you honestly believe that only you can locate the code cart and facilitate emergency care when the physician and resident have likely established their expertise long before you arrived?

No one is saying walk out but you seem to be seriously underestimating the competence of a well renowned specialist physician and his/her resident at this specialized ophthalmological & cosmetic surgery outpatient clinic.

I've seen several specialty clinics run by the physician. My son's specialist physician "closed" the specialty clinic just the other day as the receptionists had to leave by 5 and so did the nurses. The only thing he could not do (nor could the nurses as only front desk staff can enter routine & follow up appointments. Nurses can only enter urgent and post hospital appointments) was schedule the follow up. He did all the copying, completed all the forms, made copies of the diagnostic reports, wrote the referral, issued the prescriptions, initiated the pre authorization, and completed the discharge instructions.

[NotAllWhoWandeRN, ASN, RN]

They may have been to internal.med clinic, med special clinic and then wait 5 hours at eye clinic. You just never know

If you're wanting to advocate for improved patient care, perhaps the place to start would be the 5 hours you say people spend in the waiting room.

[bethburlson]

There always nurses there. It is a giant giant place

[bethburlson]

I'm talking about the hospital.

[Altra, BSN, RN]

Again why have you decided that a licensed physician and resident are incompetent at running a code when physicians must sign off on code protocols for nurses to implement? Most teaching facilities physicians and residents run codes, if not an APN. Why have you decided that your skill set is superior to that of a physician, which is how your posts are reading. It's not like you are leaving an unlicensed assistance personnel and receptionist to close a clinic. A licensed resident physician and a highly specialized physician/surgeon most certainly must be competent to run a regional referral center that accepts the patients that no one else will or erred and caused further issues.

Are you overestimating your expertise & value as a new hire? Do you honestly believe that only you can locate the code cart and facilitate emergency care when the physician and resident have likely established their expertise long before you arrived?

No one is saying walk out but you seem to be seriously underestimating the competence of a well renowned specialist physician and his/her resident at this specialized ophthalmological & cosmetic surgery outpatient clinic.

We must be reading the OP differently, because I am not sensing this kind of self-aggrandizement in the OP's posts.

What I am reading, is a disproportionate worry about leaving the clinic at the end of the workday when there are still patients being seen. IMO, in an effort to explain her discomfort with this practice, OP has offered up a number of increasingly unlikely "what if" scenarios to justify her worry. Bottom line OP -- you now work in an outpatient setting. If you believe a patient is at risk of a medical emergency, you, one of your providers, or anyone else in the outpatient setting bears the same one responsibility -- to activate emergency response. That's it.

I suggest the following:

1. OP should clarify expectations of her work schedule

2. OP should ask for clarification of the clinic's operations regarding division of duties for nurses and providers

3. OP should ask a preceptor, charge nurse, manager, etc. for some advice and perspective on outpatient care vs. inpatient care, and the differences between them.

[JustBeachyNurse, LPN]

There always nurses there. It is a giant giant place

You are not making much sense at this point.

[bethburlson]

The surgeon is ocular plastics, not glasses or contacts or cataracts.

Pts wait everywhere, that may be why the other clinics keep a nurse there

[bethburlson]

Thanks. This is a sensible post. I am currently yltrying to get this worked out

[Lunah, MSN, RN]

Thanks. This is a sensible post. I am currently yltrying to get this worked out

Please use the "quote" button when replying to posters, otherwise we have no idea who you are talking to.

[TheCommuter, BSN, RN]

Would you ask for a signed letter stating that it is ok to leave? Or would you risk your license?

Your license is not at risk in any shape, form or manner. The 'risking my license' mantra is terribly overblown because nurses do not lose their licensure over these types of situations.

In addition, your license number would need to be referred to your state's board of nursing with a complaint for your license to be at risk. Who would file the complaint? If the office managers and physicians are okay with everyone leaving, your license isn't getting referred.

Your license is NOT at risk. Drop the acute care mindset pronto. This is not an episode of Rescue 911. Good luck to you.

[JustBeachyNurse, LPN]

Thanks. This is a sensible post. I am currently yltrying to get this worked out

Your license is not at risk by following office policy and leaving patients with a highly respected qualified ocular plastic surgeon and his/her resident physician.

If you stay past your scheduled shift your job may be at risk for failing to follow protocol.

This is not acute care. The fact that nurses are last to leave on acute care wards, outpatient surgical centers or PACU is irrelevant to this specialty outpatient setting regardless of the perceived complexity of the patients. You made it clear that this is not an optometrist but a specialized ophthalmological surgery practice.

If a patient is discharged and trips on the sidewalk it's not reflective of your nursing practice and won't garner a complaint with the board of nursing.

If a medically complex elderly patient is discharged from the outpatient visit by the resident and suffers sudden cardiac death due to unknown vtach it's no ones fault that's called natural death for a reason. Your license is not at risk for turning care over to the physician and resident and leaving as scheduled (assuming they accept care and do not need your assistance).

It's irrelevant if the hospital code /rapid response team responds to emergencies in the garage or outpatient clinics. That's not your job.

It's irrelevant if the clinic manager is not a licensed healthcare professional. If you are unclear about the expectations of your job contact the nurse manager or human resources for a meeting to clarify your role, schedule and the expectations.

Your assumption that you cannot leave patients in the care of the qualified surgeon and resident is irrelevant. There are many specialists that don't even utilize nurses or other credential healthcare professionals. Many specialty clinics hire unlicensed medical assistants to save costs.

[bethburlson]

Your license is not at risk by following office policy and leaving patients with a highly respected qualified ocular plastic surgeon and his/her resident physician.

If you stay past your scheduled shift your job may be at risk for failing to follow protocol.

This is not acute care. The fact that nurses are last to leave on acute care wards, outpatient surgical centers or PACU is irrelevant to this specialty outpatient setting regardless of the perceived complexity of the patients. You made it clear that this is not an optometrist but a specialized ophthalmological surgery practice.

If a patient is discharged and trips on the sidewalk it's not reflective of your nursing practice and won't garner a complaint with the board of nursing.

If a medically complex elderly patient is discharged from the outpatient visit by the resident and suffers sudden cardiac death due to unknown vtach it's no ones fault that's called natural death for a reason. Your license is not at risk for turning care over to the physician and resident and leaving as scheduled (assuming they accept care and do not need your assistance).

It's irrelevant if the hospital code /rapid response team responds to emergencies in the garage or outpatient clinics. That's not your job.

It's irrelevant if the clinic manager is not a licensed healthcare professional. If you are unclear about the expectations of your job contact the nurse manager or human resources for a meeting to clarify your role, schedule and the expectations.

Your assumption that you cannot leave patients in the care of the qualified surgeon and resident is irrelevant. There are many specialists that don't even utilize nurses or other credential healthcare professionals. Many specialty clinics hire unlicensed medical assistants to save costs.

Yes, you are right. HR doesn't seem to know, charge nurse is off site , that's what I'm saying, it is a clown show